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[Percutaneous dilatational tracheostomy. Critical considerations after one year's experience]
Minerva Anestesiologica
|July 1, 1995
Summary
Percutaneous dilational tracheostomy (PDT) is a safe and effective ICU procedure, replacing surgical tracheostomy. While complications can occur, coupling PDT with fibrotrachoscopy enhances safety and leads to optimal outcomes.
Area of Science:
- Intensive Care Medicine
- Surgical Procedures
- Respiratory Care
Background:
- Percutaneous dilational tracheostomy (PDT) is increasingly utilized in intensive care units (ICUs).
- Indications for PDT include respiratory failure, sepsis, shock, and coma.
- Previous studies highlight potential complications associated with PDT.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous dilational tracheostomy (PDT) in a series of ICU patients.
- To identify and analyze complications associated with PDT and tracheal cannula changes.
- To assess the advantages of PDT compared to surgical tracheostomy.
Main Methods:
- A retrospective analysis of 57 patients undergoing PDT in an ICU over 15 months.
- Data collection included patient demographics, indications for PDT, pre-procedure intubation duration, and severity scores (Apache II, Saps).
- Complications during PDT, cannula changes, and post-procedure outcomes were recorded. Autopsies were performed in three cases.
Main Results:
- The primary indications for PDT were cardiac/respiratory failure (47%), sepsis (23%), shock (21%), and coma (9%).
- Complications during PDT included orotracheal tube damage, pneumomediastinum, minor bleeding (3 cases), and one major bleeding event.
- Post-cannula change complications involved tracheal shreds (4 cases) and one major bleeding episode. One death occurred due to failed reintubation after decannulation.
- Autopsies revealed procedural variations in one case (lateralized cut) and higher placement in another.
- No PDT-related infections were observed, and tracheal closure after cannula removal was optimal and fast.
Conclusions:
- Percutaneous dilational tracheostomy (PDT), especially when coupled with fibrotrachoscopy, is a safe and effective procedure in the ICU.
- While complications can arise, they are manageable, and the benefits, including reduced infection rates and faster closure, favor PDT over surgical tracheostomy.
- PDT has become the preferred method for tracheostomy in this practice, demonstrating its value in managing critically ill patients.